D2: Development Phase

The D2:Development Phase is the “planning phase”
of the 4-D Pathway. Your facility
will enter the Development Phase after successfully completing the three
tasks of the Discovery Phase and submitting the appropriate
Development Phase fee to Baby-Friendly USA (BFUSA). At that time, BFUSA
will provide your facility a Discovery Phase Registry of Intent Certificate and
access to the online Development Phase Tool Kit.

The online Development Phase Tool Kit contains a number of tools and
planning templates intended to help your facility with completing the tasks of
this phase.

The Development
Phase fee covers your facility for up to one year in the phase. During this time your
facility will develop a comprehensive plan for implementing, and sustaining,
the Ten Steps to Successful
Breastfeeding in a manner consistent with the Guidelines and Evaluation Criteria.
There are six primary tasks that must be accomplished during the Development Phase.
The Development Phase tasks are:

(1) Convene a Baby-Friendly Committee or Task Force (also
referred to as the Multidisciplinary Committee)

(2) Develop a Baby-Friendly Hospital Initiative work plan

(3) Develop an Infant Feeding Policy that supports
breastfeeding as the normal method of infant feeding and addresses all Ten
Steps to

All plans developed during this
phase are submitted to BFUSA before the facility moves on to the D3:
Dissemination Phase. BFUSA does NOT approve these plans; it
assesses and provides facilities with feedback regarding their consistency with
the Guidelines and Evaluation Criteria.

For your convenience, a timeframe
for completing the Development Phase within one year is offered below. Please be aware your facility may submit task
materials to Baby-Friendly USA ahead of the timeframes listed below. Also, the materials for all tasks are not
required to be submitted all at one time.
However, all of the materials for each individual task must be submitted
at the same time.

TASK 1 – CONVENE TASK FORCE/COMMITTEE - This should be convened immediately
upon entry into the Development Phase.

The Baby-Friendly Task Force should be multidisciplinary and consist of
individuals responsible for successfully guiding your facility through the 4-D
Pathway. The online Development Phase Tool Kit suggests key staff/disciplines
to participate on your Task Force. Be sure to include some
Baby-Friendly Champions.

TASK 2 – DEVELOP WORK PLAN - This should be developed within 3
months of entry into the Development Phase.

The online Development Phase Tool Kit provides a work plan template to assist
facilities in developing a work plan that will lead to practice change that is
both comprehensive and sustainable. The work plan should address issues
identified in the Self-Appraisal Tool completed during the Discovery
Phase as well as a review of the maternity care practices that
impact infant feeding outcomes.

TASK 3 – DEVELOP POLICY - This should be developed within 9
months of entry into the Development Phase.

A fundamental premise of the BFHI is that the hospital policy drives
practice. Step 1 of theTen
Steps to Successful Breastfeeding requires the development of a
comprehensive infant feeding policy that establishes breastfeeding as the norm
and describes how the remaining steps will be practiced at the facility.
As indicated in the policy development materials contained in the Development
Phase Tool Kit, the infant feeding policy should include all facility practices
that couldpotentiallyimpact
breastfeeding success.

TASK 4 – DEVELOP STAFF TRAINING PLAN -This should be developed within
9 months of entry into the Development Phase.

The purpose of your staff training plan is to ensure that your facility has
a comprehensive plan for helping staff gain the knowledge and practical skills
necessary to implement your facility's infant feeding policy in a safe and
effective manner. The online Development Phase Tool Kit provides details
on who should be trained and what content should be included in the training.

TASK 5 – DEVELOP PRENATAL/POSTPARTUM TEACHING PLANS (Patient
Education Plan) - This should be developed within 9 months of entry into
the Development Phase.

This task requires your facility to develop a comprehensive patient education
plan for use with prenatal and postpartum women at your facility. As
detailed in the Development Phase Tool Kit, these patient education plans
should support and enhance your facility's infant feeding policy.

TASK 6 – DEVELOP DATA COLLECTION PLAN - This should be developed within
9 months of entry into the Development Phase.

Data collection and evaluation
are vital to measuring your facility’s progress towards implementing the Guidelines
and Evaluation Criteria. The first step in this process is for
your facility to design data collection tools and plans. The Development
Phase Tool Kit contains guidance on designing your facility's data collection
plan.

Baby-Friendly USA Review of Development Phase Materials – within
6 weeks of receiving the materials.

BFUSA will review and provide feedback on your hospitals’ preliminary infant
feeding policies, work plan, staff training plan, patient education plan, and
data collection plan during the Development Phase to assess if all necessary
components are addressed and are consistent with the Guidelines and Evaluation Criteria. This
is not, and should not be considered, approval of any plan or policy. In
addition, BFUSA will not address practice guidelines that do not directly
pertain to the Guidelines and Evaluation Criteria
assessed by BFUSA. It is expected that all guidelines within the policies
be founded in current evidence and implemented in a manner consistent with your
facility’s safety protocols.

Please note: BFUSA will perform only one review of your materials during the
Development Phase.

Facility Review of BFUSA Feedback and Preparation of Roll Out Plan –
This should begin immediately upon receiving BFUSA feedback – approximately at months
10-12 of the Development Phase.

Once you receive feedback from BFUSA on the Development Phase materials, you
should convene your Baby-Friendly Multidisciplinary Committee to review the
comments and discuss how to address issues requiring some additional work. Updated plans should not be resubmitted to
BFUSA. A final BFUSA review of the
infant feeding policy will take place in the D4: Designation Phase.

You should also take these last remaining months in the Development Phase to
make decisions about which practice changes you will roll out first. It is always wise to choose a change for
which you can have an early success.
This will help inspire the staff and prepare them for the tougher
challenges.

Movement to the Dissemination Phase

Once your
facility has successfully completed the six tasks detailed above, you will be
invoiced for the Dissemination Phase fee at approximately 10 months after entry
into the Development Phase. (Facilities
completing their work early and wishing to move through the 4-D Pathway faster
may contact BFUSA and request a Dissemination Phase invoice sooner than 10
months.) Once payment is received, your facility will be moved into Dissemination
Phase. BFUSA will mail your facility a Development Phase Certificate of
Completion and will provide your facility with the online Dissemination Phase Tool
Kit.

Receipt of the
Development Phase Certificate of Completion acknowledges your facility's enrollment
into the D3: Dissemination Phase of the 4-D Pathway.

NOTE: Facilities
that have not submitted any Development Phase materials to BFUSA within 10
months of entry into the Development Phase will be invoiced for a second year
in that phase.

Additional Time in the Phase

Be aware that
every facility faces different challenges.
Some find it necessary to take longer than the timelines outlined here
to fully implement the tasks of the phase. If your facility is in this
situation, you should not feel discouraged. The culture change you are making
is enormous and sometimes requires additional time. If this is your circumstance, contact BFUSA
to learn about your options.